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Time to Contact (More on Special Report, Aug. 2007)

Article

Employers are looking for ways to improve quality and affordability. Early identification and consumer engagement strategies help minimize an employer's risk of an employee becoming a high-risk and unproductive employee.

Employers are looking for ways to improve quality and affordability. Early identification and consumer engagement strategies help minimize an employer's risk of an employee becoming a high-risk and unproductive employee.

"One of the most positive things employers can do is to encourage their employees to understand their current health condition and encourage healthful behaviors and choices at work," says Samuel Cramer, MD, vice president, clinical programs at WellPoint. WellPoint's Worksite Wellness offers nearly 20 worksite wellness education and engagement programs to help employers encourage healthy lifestyles among employees and address potential health problems as early as possible.

"Employers are very intelligent and insightful when it comes to the welfare of their employees," says OptumHealth's Harlan Levine, MD, chief clinical officer. "That's why interest is growing in [early identification and engagement] programs."

Recently, Quantum Health worked with a private-sector employer with 1,300 employees. The employer used a carrier ASO program and had purchased the carrier's DM, UR and CM services. The employer was investing heavily in wellness programs, requiring employees and spouses to participate in a health risk assessment and biometric screening or pay a higher premium.

"The carrier wasn't able to do anything with the HRA or screening data, so the employer asked us to take this data, follow up with the members and triage them to the carrier's DM program," says Kara Trott, CEO at Quantum Health.

Even though more than 600 members were identified with chronic diseases-diabetes, asthma and heart disease to name a few-and qualified for DM, the insurer had no way to help them unless they presented with a claim, and then the contact was by mail, according to Trott. "So they could not accept these members at the precise moment the member could have benefitted from assistance," she says.

For all of Quantum's employer groups, results are measured based on the claim trend for the total population. "Our clients have sustained an average claim trend of 4.51% for 5 straight years-with no reduction in benefits-in fact, adding enhancements-no cost shifting, and no other structural changes, including network discounts," she says. "Compared with the industry trend, by year five our clients' claims are running 39% below where they would have been had their claims trended at industry rates of 10% to 15% a year."

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